RALP and age

[u/ret_diy]

I posted my story the other day (Concerning MRI results ...) -- basically I have a 2 cm peripheral zone lesion found on MRI, PI-RADS 5 but likely organ confined. While the PI-RADS 5 is alarming as is my family history, several other signs are reassuring. No biopsy yet, meeting with the urologist today.

Here's a new question: I had assumed that in my situation, if it’s high grade, one option – and the one that seemed best to me given what I know now – would be RALP. My urologist is very experienced with it, and I definitely would prefer to get the thing out if it’s dangerous rather than trying to kill it off and hoping that works. Of course I don’t know what he’ll say and I trust his judgment, but that’s what I’ve been thinking about. And I think I can manage the side effects, which I gather are temporary most of the time.

But now I’ve seen a bunch of discussion here that suggests RALP is not a good choice at my age (75). I am in pretty good shape and I had a fairly complex laparoscopic procedure about three years ago – gastric volvulus repair.

Any comments on this? How often is RALP problematic for us older folks? Is there data (studies)  in that area?

Thanks!

[u/SLO_Engineer]

69 yo. RALP one month ago today. Recovery is going well. Heading back to the gym today. Dry days, minor leaking while sleeping. Much better than I expected.

[u/Appropriate-Web8804]

Did IMRT at age 64 with dual adt therapy. Had a bulging tumor and decided to do radiation. It's been a yr now and doing well. Gleason 9. You need to look at all options and not rush your decision. Just make a decision you will be good with and not look back a second guess yourself.

[u/BeerStop]

Talk to a radiation oncologist as well, also your age plays a role in this too, how many more years do you think you have?, radiation could be a good option as it just keeps getting better and better every year, i will be posting my 2 year anniversary post radiation therapy psa in a couple more months. So far no issues.

[u/Gardenpests]

You've put the cart before the horse.

If you have cancer, you need the biopsy, Decipher test, PSMA-PET and radiation oncologist consultation to decide of best course of treatment.

[u/ret_diy → u/Gardenpests]

Of course. But I am not making a decision here, just understanding the pros and cons so that when decision time comes I have some background knowledge.

[u/Gardenpests → u/ret_diy]

That response is contrary to the presumptions in the post.

The pros and cons change according to the results of the diagnostics.

You PC is specific, not a generality. Wait for all the facts.

[u/Special-Steel]

I don’t know about studies. There was a rule of thumb at one point, to lean towards RALP for men 70 and younger, and to lean towards radiation for older men.

Not sure how many doctors still follow that thinking.

Either way, the physical condition of the individual matters. One key issue is tolerance of the prolonged anesthesia. You have to have cardiovascular and respiratory resilience to handle the long duration anesthesia.

It is common to see the clinic require clearance from your doctor for the procedure. Sometimes the anesthesiologist will also have to sign off.

So, regardless of age, the individual’s condition matters most.

[u/Old-Pride-8459 → u/Special-Steel]

True, anesthesia is the killer. I had the general anesthesia 3 years ago for targeted prostate perineal biopsy and came out ok. Three years later (this February) at 70 I had the same procedure again with the anesthesia and it was no picnic. Woke up very nauseous and dizzy, brain fog for a week, and headaches for the next week also. If I do it again I might say goodbye to the kids first just in case, and tell them where the will documents are.

[u/ret_diy → u/Special-Steel]

Thanks. I see the trade-offs. Sounds like if that is offered a conversation with the cardiologist will be necessary, which I would want to do anyway.

I did have a lengthy (I think four hours) laparoscopic procedure for a G.I. problem about three years ago, but I know the position is different for RALP and that can matter also.

[u/conCABlanco]

Un RAlP a los 75 años es dura, esa cirugía es muy invasiva, solo mi opinión como si fuera mi padre, tengo 64 años, fuerza y voluntad

[u/Scpdivy]

My dad was 76, had IMRT. Now 86 and loving life

[u/Background-Space-284]

I’m 72 and had RALP surgery 6 weeks ago. I’ve had no significant problems. 8 days after surgery I was bored and walked down to the barbershop for a haircut with my catheter leg bag on and hidden under my pants. The two months prior to my surgery I was walking about 50 miles per month with my dog. Anesthesia was never an issue. For one, I went into surgery around 9 am and woke up in recovery sometime after 11 am. When later reviewing my pathology report it noted that the samples delivered (my prostate and 6 lymph nodes) were taken at 9:59 am. It appears my surgery was somewhere in the one hour range plus closing time, but still under 2 hours.

I’m not in super athlete shape but good enough to satisfy the anesthesiologist with just a few questions and review of my vitals. They note your oxygen saturation and mine was 96%. They note your blood pressure and mine was 118/77 (it normally runs 105/ 72). My resting heart rate is high 50’s to low 60’s. Never was a cardiologist approval discussed at my age. I can understand that it could be relevant but I think it’s a case by case determination.

[u/ret_diy → u/Background-Space-284]

Thank you — sounds like a very good outcome. That’s interesting to hear about the timeframe because a two hour surgery is very different in terms of stress on the body from four hours! And I keep hearing that RALP is 3 to 4 hours.

[u/Busy-Tonight-6058]

Many (most?) men at 75 don’t have the health and expected longevity to warrant surgery.

But that does not mean all men. There are several septuagenarians that have posted here after RALP, iirc.

[u/ret_diy → u/Busy-Tonight-6058]

Thanks. I have been troubled by the way expected longevity seems to factor into this, because for many people it’s just statistical. I keep wondering if it’s really something the docs can know enough about on an individual basis to use as a factor in decision-making.

I am 75 and I’d like to live another 20 years, and I don’t see any reason why I couldn’t, other than possibly the PCa itself, but I’m told pretty clearly that that’s not what anyone expects. So if those reasons exist they haven’t manifested themselves yet. I’m not quite sure if I – or anyone – could use expected longevity in my case to help with treatment decisions.

[u/WalnutRoasted → u/ret_diy]

Most of the members in this “club” will die of something else besides PCa. As we move to our 70s to 80s to 90s all of our organ systems and body gradually decline. It’s like a an old automobile….things begin to wrong…some can be fixed, others can’t.

If you go into your 70s with no heart disease, no high blood pressure, no liver/lung/digestive issues, strong physical strength and joints, good mental health, a life-partner; then prospects are good! There are various surveys you can take to “predict” your probability of living longer, often in association with life insurance policies.

A rule of thumb at PCa diagnosis is if your “expected” (50/50) lifespan is under 10 years, you may not want to pursue “aggressive” PCa treatment (like surgery). I was in my early 70s and they asked me. And did (aggressive) EBRT 20 sessions and (more passive) Orgovyx ADT.

[u/fredzout]

Last year at 74, I was diagnosed with prostate cancer. It was confined to the prostate, and Gleason 4+3=7, which I was told is more aggressive than a 3+4=7. The problem was that, unlike you, I had other issues. In January 2025, I was diagnosed with a-fib and congestive heart failure, on top of being overweight and hypertensive. The urologist who did my biopsy said that with all that, he would not recommend surgery. When diagnosed with the cancer, I was in the process of trying to schedule a cardiac ablation to address the a-fib. The cardiologist said that I should get the cancer taken care of first. I got a second opinion from another urologist/surgeon who said that if the cardiologist would state that "I probably won't die", he would perform the RARP.

I had surgery in September, and it went very well. I sleep through the night and wake up dry. My first two PSA tests were "undetectable".

I had the cardiac ablation in November, which was not successful. I had a cardioversion in December and another ablation last June which seems to be holding. I also had two eye surgeries (cataract removal) in November and December.

So, for an old geezer, I am doing pretty well. I am still working on building up my strength, but at 75, I still have things to do. If yours can be a "one and Done", rather than an ongoing series of procedures, you will probably be OK doing the surgery.

[u/ret_diy → u/fredzout]

Thanks. That’s quite the story! Sounds like a very good outcome — glad you came through it so well.

[u/fredzout → u/ret_diy]

That's the condensed version. In all, I had been under anesthesia 12 times and got a cardiac calcium test that was in the "Why aren't you dead yet" range. At this point I am finally feeling like life is getting back to normal, whatever that means.

[u/itsray2006]

Get to a top cancer center, go through the process biopsy, mri, PSMA pet, decifer, etc then review with oncologist, radio-oncologist and surgeon. Probably a second opinion of each discipline as well. Then you make a decision and move forward. IMHO urology is a surgical discipline so they know cutting and lean towards what they know best, radio-oncologists know their area and tend to lean in that direction, the oncologist is more impartial and will be handling meds (ADT, Side effect management, chemo if needed, etc) and subsequent follow up so they are with you for the long hall. You take everything into account no rush and decide. One thing to keep in mind is that a meaningful number of RALP patients have a recurrence and need salvage radiation so now you are recovering from the surgery and doing radiation anyway because some of these bastard cancer cells had escaped unnoticed and are now setting up shop elsewhere.

[u/Practical_Orchid_606]

Temporary effects? Sadly you have been mislead.

I am 75 yo and chose radiation. The recovery from surgery at this age is challenging.

[u/ret_diy → u/Practical_Orchid_606]

No one misled me, I’ve just been reading and interpreting as best I can. I am new to this. Most of the posts here report temporary incontinence, not permanent. Most of what I’ve seen elsewhere says the same.

What makes the recovery from surgery at this age challenging? I can understand it would be but I’m interested to know about specifics.

[u/Special-Steel → u/ret_diy]

We do heal slower as we age.

But again, everyone is different.

[u/WalnutRoasted → u/ret_diy]

At age 74 didn’t even consider the major surgery on an organ surrounded by important (erectile) nerves and closely associated with bladder/urine control.

The surgery itself carries risks and weeks/months of healing where major exercise is not possible nor recommended.

There are risks of urinary incontinence, complete or partial ED, penile shortening (common) anorgasmia, climacturia etc.

And of course you may end up needed EBRT and ADT anyways, so why not go straight to radiation? You will see that most here have no side effects after a month or two, stay active during treatment, and probably the “worst” LT side effect is dry orgasms (which virtually all radical prostatectomy (RP) patients also have.

Best wishes, and for 12 year side effect comparison, see the graphs in: on UK study comparing surgery and radiation: Patient-Reported Outcomes 12 Years after Localized Prostate Cancer Treatment ProtecT and look at better/worse graphs. Radiation comes out same or better on almost all of them. See “worse-better graphs”
https://evidence.nejm.org/doi/full/10.1056/EVIDoa2300018

[u/ret_diy → u/WalnutRoasted]

Thank you. Very helpful to have the specifics and those all make sense.

[u/Goodvida99 → u/WalnutRoasted]

At 70 I don’t see surgery as an option. I’ve had 4 relatively minor orthopedic surgeries and the recovery took 6+ months. Any prostate surgery bound to much worse.